Value Stream Mapping

Value Stream Mapping (VSM) is one of the essential Lean tools used to document, analyze and improve the flow of information, materials or people required to provide services and create value for patients and other stakeholders. By incorporating fundamental Lean concepts, VSM helps identify the sources of waste in a value stream, differentiate between valued-added and non-value-added activities, optimize decision making, provide common language, and streamline critical processes across organizational or departmental boundaries. VSM can also include value-enabling activities that do not directly create value as specified by patients and other stakeholders, but have to be performed in order to enable effective functioning of the processes, maintain financial stability of an organization, and meet legal and regulatory requirements. For example, accounting, payroll processing, recruitment, capital planning, preventive maintenance, and purchasing processes are generally considered value enabling activities that cannot be completely eliminated from a system. In essence, VSM represents a blueprint for action and starting point for system optimization and collaborative process improvement efforts. For the sake of simplicity, the basic value stream mapping steps are presented below as distinct elements. However, in practical applications VSM employs an iterative process with overlapping and interconnected steps.

While there are no guarantees with VSM, adherence to the following guidelines will significantly increase the likelihood of success:

Identify a value stream that is manageable in scope, establish interprofessional team, decide on the improvement goals, and define project boundaries

Ensure appropriate representation from all departments, units and functions that work in the selected value stream but also take advantage of having a “fresh pair of eyes” on the team

Establish a sense of common purpose and be perfectly clear on what represents value from the viewpoint of patients and other stakeholders

Conduct an initial walkthrough of the entire value stream to understand the flow, get a snapshot of the actual processes and document the main process steps

Begin mapping activities at the end of the value stream where processes are linked most directly to the patients and continue working further upstream

Use a pencil, photos and sticky notes to capture essential information and map process steps and activities on a large sheet of paper

Conduct another but more detailed walkthrough of the value stream and personally collect data that accurately reflect current reality

Facilitate conversation with front line staff and engage in active listening

Consolidate all available information, create a current state map, document any assumptions, and identify areas that may require further investigation

Verify accuracy of the current state map through additional data collection and/or repeated process observations

Analyze the current state map and identify the sources of waste, non-value-added activities, process bottlenecks, and the root cause of problems

Identify opportunities for improvement and prioritize problems according to their risk level and the overall impact on patients, organization and other stakeholders

Develop an ideal future state map to show how processes should work in ideal circumstances and to create a shared vision to work towards

Develop a realistic future state map to provide a roadmap for short-term improvements while taking into consideration existing organizational, financial and technological constraints

Continue to improve the value stream maps as increasingly detailed, accurate and specific information becomes available

Resist the temptation to finalize the future state maps before achieving complete understanding of the current state

Break down functional silos, involve front line staff in a meaningful way, elicit strong leadership support, and develop an integrated action plan to move toward the desired future state

Design, develop and implement a robust monitoring and control system to identify variances from the action plan, take preventive and corrective actions, minimize risks, and report progress on a regular basis

Use a balanced mix of quantitative and qualitative measurements to establish the baselines, encourage ownership, monitor performance, and evaluate the impact of change

Recognize, reward and celebrate success

VSM may appear similar to a flowchart and other visual process improvement tools that show process steps, tasks, activities, and decision points in sequential order. Unlike the traditional flowcharts that lack the element of time and tend to concentrate on a single process, VSM is a graphical representation of the entire value stream that captures time elements and often involves a large number of interconnected processes. Taking a broader view of the system makes it possible to drive strategically important improvements while minimizing the risk of system suboptimization that could result from making isolated improvements within the boundaries of individual departments. VSM displays a wide range of useful information that may include cycle time, processing time, lead time, changeover time, waiting time between process steps, takt time, yield, inventory, safety stock, defects, required human resources, equipment downtime, improvement opportunities (“kaizen bursts”), and other pertinent data. Information flow is typically drawn in the top half of the VSM and it shows main communication channels among departments, patients, individual healthcare providers, and various information systems. The process steps that outline the flow of patients, healthcare providers, products, materials, and equipment are shown in the bottom part of the VSM. However, the level of detail, icons used, format, and overall appearance of the VSM are often customized to address specific circumstances, reflect the level of work complexity, and meet organizational needs and team preferences. An example of the customized, high-level Current State VSM for Interventional Radiology (IR) patients is provided below.